婴幼儿颅骨生长性骨折的诊断和治疗  

Diagnosis and treatment of growing skull fracture in infants and young children

作　　者：叶磊[1] 余伟[1] 宋志杰[1] 张堃[1] 杨雷[1] 

机构地区：[1]昆明医科大学附属儿童医院神经外科,昆明650228

出　　处：《重庆医科大学学报》2015年第5期797-800,共4页Journal of Chongqing Medical University

摘　　要：目的：探索婴幼儿颅骨生长性骨折（growing skull fracture,GSF）的发病机制、临床表现、影像学和外科治疗的特点。方法：对2009年至2014年收治的11例GSF患儿临床资料进行回顾性分析,分析其临床表现特点、发病机制、影像学特点。所有患儿均接受手术治疗,手术予以硬膜修补,颅骨骨片复位。结果：11例患儿年龄从6月~3.6岁,均有明确脑外伤病史,临床症状主要包括颅骨缺损、局部搏动性包块和神经功能障碍。CT颅骨三维重建可发现颅骨分离,局部假性囊肿形成,伴有局部脑软化。骨折缝宽度为1.5~3 cm。10例行硬膜和颅骨成形术,1例行颅骨修补术,术后均愈合良好。术后随访6~24月。结论：GSF主要发生在婴幼儿,颅骨骨折和硬膜撕裂是GSF形成的决定因素。一旦确诊GSF需尽早行颅骨成形术,术中需严密修补硬脑膜,同时将骨折缝两侧颅骨重新整复塑性用颅骨连接片固定。Objective：To discuss the pathogensis,clinical features and treatment of growing skull fractures（GSF）in infants and young children. Methods：Eleven subjects with growing skull fractures in past five years were investigated retrospectively in Kunming ＇s Children＇s Hospital between 2009 and 2014. The clinical symptoms,pathogensis and imaging characteristics were analyzed. All patients received the surgery. Cranioplasty was carried out while the dura was repaired. Results：The age of the patients ranged from 6months to 3.6 years. All 11 subjects had the history of head trauma,and the clinical symptoms included skull defect,soft pulsatile mass and neurologic dysfunction. The cysts in the defect area and encephalomalacia were shown clearly by CT scan. The width of fracture ranged from 1.5 cm to 3 cm. Ten patients underwent the duraplasty and cranioplasty surgery with autogenous bone,and 1 patient underwent cranioplasty with Titanium plate fixation.All patients recovered well. All patients received follow-up from 6 to 24 months. Conclusion：GSF only occur in the infants and young children. The most important factors of GSF include skull fracture and dural tear. The duraplasty and cranioplasty surgery is necessary once the GSF is diagnosed. The key procedure is to perform a watertight dura.

关 键 词：生长性骨折 婴幼儿 颅骨和硬膜成形术 

分 类 号：R726.1[医药卫生—儿科]